Organization
GREAT LAKES CLINICAL CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA BAXTER LMSW (CLINICAL SUPERVISOR)
(248) 443-5613
Entity
Organization
Contact information
Practice address
22350 LUCERNE DR, APT 201, SOUTHFIELD, MI 48075-5953
(248) 443-5613
Mailing address
22350 LUCERNE DR, APT 201, SOUTHFIELD, MI 48075-5953
(248) 443-5613
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6801087398
MI
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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